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2008 Annual Meeting Abstracts



Living Donor Kidney Transplantation with Multiple Arteries: Recent Increase in Modern era of Laparoscopic Donor Nephrectomy

REZA SAIDI, Tatsou Kawai, Peter Kennealey, George Tsouflas, Nahel Elias, Martin Hertl, A.B. Cosimi, Dicken S.C. Ko.
MASSACHUSETTS GENERAL HOSPITAL, BOSTON, MA, USA.


Objective: To evaluate of outcome of living donor kidney transplantation (LDKT) with multiple arteries (Group I) compare with single artery (Group II)
Design: Retrospective
Setting: Tertiary center
Patients: 350 patients who underwent LDKT form January 2000 to March 2007.
Interventions: LDKT
Main Outcome Measures: Surgical complications, allograft survival
Results: Of 31 patients in Group I, there were 2 arteries in 21 grafts (67.8%), 3 arteries in 6 (19.3%) and 4 arteries in 4 (12.9%) grafts.
The operative time was longer in Group I compared to Group II; 259+-48 vs. 173+-35 minutes (p<0.001).
There overall surgical complication rate in Group I and II were comparable (9.6% vs. 9.7%); vascular_2.8% vs 3.2%, urological_1.6% vs 3.2%, symptomatic lymphocele_2.8% vs 3.2%, and wound infections_2.8% vs 3.2%.
The actuarial 1 and 5 year allograft survival rates were comparable in both groups; 96.8% and 87.1% in Group I and 98.4%, 91.5% in Group II.
The utilization of allograft with multiple arteries showed dramatic increase in recent years; 7.8% (n=10) in grafts which were procured by open technique (n=127), 4.1% (n=5) during our initial experience with laparoscopic nephrectomy (n=123) and 16% (n=16) in the most recent 100 cases, (p<0.01).
Conclusions: Living donor kidney transplantation in the presence of multiple renal arteries is feasible and safe. Additionally, graft survival and graft function are not adversely impacted by the presence of multiple renal arteries in grafts procured laparoscopically. Recently, there is a rise in incidence of using kidneys with multiple arteries with excellent results.
Surgical Compilations: single vs. multiple arteries
Surgical Compilations: single vs. multiple arteries
Numbr of arteries/ComplicationsSingle artery n (%)Multiple arteries n (%)
Vascular complication9 (2.8%)
anastomotic bleeding (n=8)renal vein hrombosis (n=1)
1 (3.2%)anastomotic bleeding
Urological complication5 (1.6%)
leak (n=1)
obstruction (n=1) stricture (n=3)
1 (3.2%)Stricture (n=1)
Symptomatic lymphocele9 (2.8%)1 (3.2%)
Wound infection9 (2.8%)1 (3.2%)


 

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